Migraine

Ok, so I had my first appointment with my new neurologist, which I will post about in more detail later, but he's making a LOT of changes to my current med situation and I just want to bounce it out there and make sure no one sees any red flags that I push him on...

He's lowering my Topamax back down to 50mg--I agree with this 100%, I think it will be a better dosage for me, I think we may remove Topamax 100%, but I don't think it's been decided yet. However, it's lowering the dosage 50mg at a time, instead of 25mg. He has it planned out 50mg down every 10 days. He told me this and then asked, "Is that ok" and granted, I should have said, "Is that really the best thing, since I went up in 25mg increments?" I just felt unsure of myself, he's the doctor, 50mg isn't really that big of a difference, but now I'm wondering. I go back to the office on Friday for a test, so I cann ask him in person if I can change it... what do you guys think?

Second question... I didn't get the full grasp of all my meds until I was basically done with my appointment, but I am going to be on the Topamax (changing dosage, eventually 50mg), Lexapro (10mg) and Gapapentin (300mg)--all at once. Does that seem like too many? I seem to recall posts before that make me feel like more than one preventative at one time is not the norm/suggested? Right now I don't have a follow up appointment for three months, so I assume he plans to keep me on the combo for some time unless it causes problems for me, but again, if it's at all a red flag, I'd rather mention it on Friday and avoid it altogether.

hey there!

i think if you are worried about the amount of drugs you should def bring it up! Otherwise you will be taking them and worrying about it for the next three months! let us know what he says!

I would discuss starting multiple new medications at one time with your doctor on Friday. My neurologist feels very strongly that in most circumstances I should only be started on a single new medication at a time to better determine if there are any problems with the drug.

I have also read postings of others that they are started on multiple new medications at one time. I think it depends on the physician and their individual experiences. Probably also the individual patient's circumstances.

But ask, it is always good to be clear on your provider's phylosiophy on this type of issue.

She also end the appointments with the time frame for the follow up with the notation, unless there are problems and then we'll see you sooner.

Take care,

Cindy

Well, although I was "scheduled" for three months out to follow up... and that seemed like forever... he also told me "If you aren't feel good in six weeks, you call me." So I felt like 1. he's feeling really confident about this change/combo 2. I'm welcome to make an appointment sooner if something isn't working for me. I'm assuming that will probably happen. I didn't bother listing it, but he also wants me to start taking Migravent, if you've heard of it... it's an OTC supplement with Butterbur and other herbs that are supposed to help with migraines. He also wants me to start taking folic acid.

I appreciate the idea of shock & awe... get me feeling a difference in a hurry, but I also see the much more logical sense of one at a time, monthly appointments--actually paying attention to each med and how it's affecting you. With this regimine I'll have no idea which med is causing which side effects. I guess that answers my question for me, and I need to address it with him, at least for the combo of all the meds at once. I'm fine with the three month appointment, only because either 1. I'll feel fantastic and won't care that I'm not seeing him or 2. I won't feel great and I'll be calling him.

I'm still unsure if I just question him about the Topamax... or whether 50mg is totally reasonable. I'm guessing it's totally fine for avoiding things like seizures, which I suppose is the real reason to make sure you ease off of Topamax.. I guess you ease on really slowly to avoid side effects, maybe there isn't as much cause for easing off just as slowly, so long as you don't incite seizures.

I agree that the best thing is to ask your doctor about your concerns.

My specialist changed/added several things the first time I saw her, all at once. I was a little concerned; my local neurologist is very conservative and doesn't like to start more than one med at a time. But I decided to try it.

I'm feeling much better, and I'm willing to believe that it's the combo.

As far as taking more than one preventive, I'm currently taking Lamictal, Lyrica, verapamil, magnesium and Moban. Plus she changed one of my antidepressants from Effexor to Cymbalta. She made the Cymbalta change and added the Lyrica and magnesium at the first appointment. She added the verapamil at my last appointment.

My local neurologist says that from 3 to 6 months is required to give a preventive med a fair trial. That may be why your doctor doesn't want to see you for 3 months, to give the meds a fair trial.

Let us know what he says.

Gretchen in Mississippi

My current preventives are these:

Inderal
Magnesium
Vitamin B2
Celexa

It's pretty common to need more than one preventive at a time.

Are you ready?

Methazolimide
Zonegran
Wellbutrin
toprol
Synthroid.

Now, the well and top are for other things, but do help with Migraine prevention.

I think it was the two anti-seizure meds that weirded me out... but I suppose I'm freaking out about nothing.

Candace, my rule of thumb is to just call the office and ask the question if I have concerns - otherwise I'll just spend too much energy worrying about it. That way you'll know if you should be concerned, and you'll understand your new doc's reasoning a bit better.

Glad to hear this guy is more reasonable than your last one.